Immunosuppressive Therapy

Question 0

When are immunosuppressive drugs used?

Answer 0

Transplants, grafts, autoimmune disorders

Question 1

What is an immunosuppressive drug?

Answer 1

Used to prevent production of antibodies

Question 2

Calcineurin inhibitors

Answer 2

Cyclosporine and tacrolimus, used for transplants

Question 3

Calcineurin inhibitors effect on immune system

Answer 3

Number of T lymphocytes is reduced, so T cell dependent B cell responses are inhibited, leading to overall immune response decrease

Question 4

Cyclosporine is given…

Answer 4

IV, oral, or ophthalmic

Initially oral because of absorption variability

Question 5

Ophthalmic Cyclisporine

Answer 5

Used for keratoconjunctivitis sicca (dry eyes syndrome)

Question 6

Cyclosporine uses

Answer 6

Solid organ transplant, dry eyes syndrome, graft versus host disease, and autoimmune (RA)

Question 7

Cyclosporine is not frequently a first line defense…

Answer 7

Because of its toxicity

Question 8

Cyclosporine adverse effects - nephrotoxicity

Answer 8

Most common and concerning, can cause HTN, use calcium channel blockers to treat

Question 9

Cyclosporine adverse effects - neurotoxicity

Answer 9

Mild tremor, HA/seizures, blindness

Question 10

Cyclosporine adverse effects - other

Answer 10

Increased viral and fungal infection, increased risk of cancer, hyperkalemia, hypomagnesemia, glucose intolerance, hyperuricemia (High blood uric acid level)

Question 11

Cyclosporine monitoring parameters

Answer 11

Renal function
Blood pressure
Serum electrolytes and mag
LFTs (can elevate bilirubin)

Question 12

Tacrolimus is given….

Answer 12

IV, oral, topical

Question 13

Topical tacrolimus

Answer 13

Used for severe plaque psoriasis and severe atopic dermatitis

Question 14

Tacrolimus uses

Answer 14

Preventing organ rejection

W/ methotrexate for prevention of acute GVHD

Question 15

Tacrolimus adverse effects

Answer 15

Nephrotoxicity (HTN) HA, tremors, paresthesias (pins and needles), coma, dyspnea, N/V diarrhea, fatigue, hyperkalemia, hypomagnesemia, hyperglycemia

Question 16

Tacrolimus monitoring parameters

Answer 16

Renal function
Electrolytes and mag
Bloop pressure
Fasting blood glucose
Tacrolimus levels

Question 17

TAcrolimus use is decreasing because

Answer 17

Other less toxic drugs are being released

Question 18

Sirolimus MOA

Answer 18

Binds to intracellular proteins and inhibits growth of hematopoietic and lymphoid cells

Question 19

Sirolimus is used…

Answer 19

As a second line agent for use in combo with other immunosuppressive agents for prophylactic organ rejection

Question 20

Sirloin is adverse effects

Answer 20

N/v, diarrhea, elevation of LFTs, hypertroglyceridemia, thrombocytopenia (low platelets), neutropenia, blood pressure changes, HA, mucous membrane irritation, Infections, epistaxis

Question 21

Sirolimus monitoring parameters

Answer 21

Lipid panel
CBC
blood pressure
Platelets

Question 22

Prednisolone MOA

Answer 22

Interacts with DNA to inhibit production of almost all cytokines and pro inflammatory mediators

Question 23

Prednisolone effects

Answer 23

Anti-inflammatory, inhibits innate immunity by suppressing phagocytic function of neutrophils and macrophage, causes neutrophillic leukocytosis (high neutro count), decreases number or circulating T cells, with chronic admin decreases IgG and IgA

Question 24

Prednisolone uses

Answer 24

``` Organ rejection prophylaxis Autoimmune diseases Inflammatory disorders Allergic conditions Malignancies ```

Question 25

Prednisolone Adverse effects

Answer 25

Related to dosage, more common with long term: Skin thinning and purpura, Cushing appearance and weight gain, cataracts and glaucoma, HTN and hyperlipidemia (can lead to atherosclerosis), gastritis, ulcers, may increase appetite

Question 26

Prednisolone adverse effects continued

Answer 26

Osteoporosis, initially euphoria and insomnia, can cause depression and mania/psychosis, hyperglycemia leading to DM, hypothalamic-pituitary-adrenal insufficiency, typical and opportunistic infections

Question 27

Prednisolone monitoring parameters

Answer 27

``` Bloop pressure CMP - glucose Lipids Glaucoma and cataracts DEXA scan - osteoporosis ```

Question 28

Azathioprine (imuran) MOA

Answer 28

Antimetabolite, inhibits synthesis of proteins

Question 29

Azathioprine (imuran) uses

Answer 29

``` Renal homografts Autoimmune diseases (SLE (lupus), RA) ```

Question 30

Azathioprine (imuran) adverse effects

Answer 30

Fever, nausea, bone marrow suppression leading to anemia leukopenia (increased infxns) platelet decrease (bleeding), hepatotoxicity (exclusion), skin cancer

Question 31

Azathioprine (imuran) monitoring parameters

Answer 31

CBC with platelet counts weekly, hold if neutropenia until WBC count rises LFTs, total bili, alkaline phosphatase

Question 32

Cyclophosphamide MOA

Answer 32

Alkylating agent, damages DNA | Most potent immunosuppressive therapy

Question 33

Cyclophosphamide uses

Answer 33

Leukemias and lymphomas Severe glomerulonephritis Rheumatoid vasculitis

Question 34

Cyclophosphamide is given...

Answer 34

Intermittently or as a daily dose

Question 35

Cyclophosphamide adverse effects

Answer 35

Severe n/v, myelosuppression, hemorrhagic cystitis, hepatitis, cardiac damage, pulm fib, opportunistic infxns, later malignancies

Question 36

Cyclophosphamide (CYC) and the Bladder

Answer 36

Toxic metabolite (acrolein) can cause hemorrhagic cystitis, bladder cancer

Question 37

Reduce risk of acrolein toxicity by....

Answer 37

Hydrating adequately | Admin of MESNA (inactivates acrolein)

Question 38

CYC monitoring parameters

Answer 38

CBC with diff Renal function with UA for blood LFTs Annual UA, any blood at all = cystoscopy